Healthcare Dilemma: Private Hospitals Preferred -Unravelling the reason behind Patient Choices in the PMJAY scheme

Abstract

Purpose -This study aims to identify the reasons behind the high claim ratio in private hospitals under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) health insurance system. Additionally, by analysing the current system, examining the variables influencing the uptake of health insurance in public hospitals, and looking at the diseases not covered by the policy, it seeks to determine the advantages and disadvantages of the high standard of care offered in these facilities.

Methodology- The method of qualitative research was used. The core data gathered from field (hospital) visits and interactions with Ayushman Bharat patients serves as the foundation for their preferences and the high standard of care they receive. A thematic analysis is conducted based on the gathered data.

Findings- In terms of facilities, quality standards, and the capacity to deliver a certain range of services, private hospitals usually provide advanced medical treatments and specialized medical services. Were as in public hospitals lack in providing information about the PMJAY scheme, leading to coverage limits and denied services. Investigations are needed due to a lack of medical professionals and outdated equipment.

Suggestion- The study proposes to increase awareness through various sources and accessibility of prompt hospitalization for palliative care, while implementing measures to reduce medication costs and Ayushman Health coverage renewals.